Coalition proposes Medi-Cal rate increase legislation

CDA continues to work with other health care organizations to address the worsening access crisis for Medi-Cal patients and the extremely low provider reimbursement rates in the Medi-Cal program. New legislation introduced last week, SB 243 and AB 366, sponsored by the We Care for California coalition, would not only reverse the 10 percent reimbursement rate cut the state began implementing in 2013, but also raise Medi-Cal reimbursement rates to the equivalent of what the federal Medicare program pays – this would amount to approximately a 38 percent increase for dental services.   

The bills, authored by Sen. Ed Hernandez (D-West Covina) and Asm. Rob Bonta (D-Oakland), chairs of the Senate and Assembly Health Committees respectively, will help draw attention during budget negotiations to the growing crisis for Medi-Cal patients trying to access care and the need for an immediate, comprehensive fix.

A state audit released last December found that more than half of the children enrolled in Medi-Cal are not receiving any dental care and that the majority of counties have an insufficient number of dental providers. The audit pointed to low reimbursement rates as a key factor, noting that rates paid for the 10 most common dental procedures are only 35 percent of the national average.

Moreover, in addition to the 2013 cut, a federally funded rate increase for primary care providers (which did not include dentists) expired at the end of 2014, resulting in immediate payment reductions of approximately 50 percent.

“The Medi-Cal program remains one of the lowest-paying Medicaid programs in the country even as millions of new patients are enrolling in the program,” CDA President Walt Weber, DDS, said. “The state needs to ensure the program has the resources it needs, as these bills would provide, so that patients do not just have coverage but also real access to care.”    

With a recent expansion in Medi-Cal eligibility, more than 12 million Californians are now receiving their medical and dental benefits through the program, including half of all children.

The We Care for California coalition, which formed in 2013 in response to the 10 percent rate cut, includes CDA, physicians, hospitals, health care workers, community health clinics, health plans, first responders, caregivers and other health providers.  

SB 243 and AB 366 will be discussed in legislative committee hearings in March and will be a part of budget discussions. The Legislature must adopt a budget by June 15.

Updated 02/26/15